New client information
Impact utilizes an online intake process. Once an appointment is requested via our website, you will be contacted via email to begin the new client intake process:
Impact Clinical Consulting, LLC is here for all your therapeutic needs. We look forward to the opportunity to work with you and/or your family.
At Impact, we are currently offering both in-office and telehealth options. Although, we recommend and encourage in-office appointments for children.
All new clients are required to complete our New Client Intake Packet. Included in this packet are required demographic, medical/mental health history, description of need, consent, and payment forms. The intake forms must reflect the information of the person(s) who will be receiving services.
The forms included in the intake paperwork packet are:
- New Client Form – Requests demographic information, medical and mental health history, and description of how Impact Clinical Consulting, LLC can support your family.
- Notice of Privacy Practices – Describes how health information may be used and disclosed and informs clients of their rights under HIPAA.
- Practice Policies – Provides important information about payments, missed appointments, and agency policies.
- Informed Consent Form – Allows Impact to provide services.
- Telehealth Informed Consent Form – Allows Impact to provide services via video platform.
- Credit Card Authorization Form – Allows Impact to bill for services provided.
- DASS-21, SDQ, and/or, DSM-V Cross Cutting Symptoms Measure – Standardized symptom measures to assist in psychodiagnostics.
Impact Clinical Consulting, LLC does not bill private insurance companies or Medicaid for services provided. We are a self-pay agency. The cost of service is due at the time the service is rendered.
We hope you choose Impact Clinical Consulting, LLC for all your Wellness needs.
Please do not hesitate to contact us with any questions or concerns.
